Jerilyn K. Allen

Mobile phone interventions to increase physical activity and reduce weight: A systematic review

OBJECTIVE This systematic review was conducted to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions to promote weight reduction and physical activity. METHODS Studies of smartphone applications and text messaging interventions related to the cardiovascular risk factors of physical inactivity and overweight/obesity published between January 2005 and August 2010 were eligible. Studies related to disease management were excluded. Study characteristics and results were gathered and synthesized. RESULTS A total of 36 citations from CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were identified; 7 articles were eligible for inclusion. The most frequent outcome measured in the studies was change in the weight of participants (57%). More than half of the studies (71%) reported statistically significant results in at least 1 outcome of weight loss, physical activity, dietary intake, decreased body mass index, decreased waist circumference, sugar-sweetened beverage intake, screen time, and satisfaction or acceptability outcomes. CONCLUSIONS All of the technology interventions that were supported by education or an additional intervention demonstrated a beneficial impact of text messaging or smartphone application for reduction of physical inactivity and/or overweight/obesity. More rigorous trials that determine what parts of the technology or intervention are effective as well as establishment of cost-effectiveness are necessary for further evaluation of smartphone and text messaging interventions.

Disparities in women's referral to and enrollment in outpatient cardiac rehabilitation.

AbstractOBJECTIVE: The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs. DESIGN: Prospective longitudinal design. SETTING: One large academic medical center and two large community hospitals. PATIENTS: A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up. MAIN RESULTS: The rate of referral to outpatients phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P=.03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P=.03). Controlling for age, education, angina class, and comorbidities, women with annual incomes <

Allostatic load: a mechanism of socioeconomic health disparities?

20,000 were 66% less likely to be referred to cardiac rehabilitation (P=.01) and 60% less likely to enroll compared to women with incomes >

Fatigue after stroke: Relationship to mobility, fitness, ambulatory activity, social support, and falls efficacy

20,000 (P=.01). Although borderline significant, African-American women were 55% less likely to be referred (P=.059) and 58% less likely to enroll (P=.059) than white women. CONCLUSIONS: We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities.

Socioeconomic status is associated with frailty: the Women’s Health and Aging Studies

Although research on health disparities has been prioritized by the National Institutes of Health, the Institute of Medicine, and Healthy People 2010, little has been published that examines the biology underlying health disparities. Allostatic load is a multisystem construct theorized to quantify stress-induced biological risk. Differences in allostatic load may reflect differences in stress exposure and thus provide a mechanistic link to understanding health disparities. The purpose of this systematic review is to examine the construct of allostatic load and the published studies that employ it in an effort to understand whether the construct can be useful in quantifying health disparities. The published literature demonstrates that allostatic load is elevated in those of low socioeconomic status (SES) as compared to those of high SES. The reviewed articles vary in the justification for inclusion of variables. Recommendations for future research are made in the contexts of measurement, methodology, and racial composition of participants.

Improving Quality of Care Through Disease Management Principles and Recommendations From the American Heart Association’s Expert Panel on Disease Management

&NA; Fatigue is common and persistent in stroke survivors, yet it is not known how mobility deficits, fitness, or other factors, such as social support, relate to fatigue severity, or whether subjective fatigue contributes to reduced ambulatory activity. The severity of fatigue in a sample of 53 community‐dwelling subjects with chronic hemiparetic stroke was examined, and relationships among fatigue and mobility deficit severity, cardiovascular‐metabolic fitness, ambulatory activity, social support, and self‐efficacy for falls were identified. Measures included the Fatigue Severity Scale, timed 10‐meter walks, the Berg Balance Scale, submaximal and peak VO2, total daily step activity derived from microprocessor‐linked Step Activity Monitors, the Medical Outcomes Study Social Support Survey, and the Falls Efficacy Scale. Forty‐six percent of the sample had severe fatigue. Fatigue showed no relationship to ambulatory activity. Fatigue severity was associated with the Berg Balance Scale (p > .01) and falls efficacy (p > .01), but not with cardiovascular fitness variables. Patients with elevated fatigue severity scores had lower social support (p > .05) and poorer falls efficacy scores (p > .05) than patients reporting less fatigue. Only falls efficacy was predictive of fatigue severity (r2 = 0.216, p > .01). Further studies are needed to evaluate whether rehabilitation strategies that include not only fitness and mobility interventions, but also social/behavioral and self‐efficacy components, are associated with reduced fatigue and increased ambulation.

Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion

Background: Frailty is a common risk factor for morbidity and mortality in older adults. Although both low socioeconomic status (SES) and frailty are important sources of vulnerability, there is limited research examining their relationship. A study was undertaken to determine (1) the extent to which low SES was associated with increased odds of frailty and (2) whether race was associated with frailty, independent of SES. Methods: A cross-sectional analysis of the Women’s Health and Aging Studies using multivariable ordinal logistic regression modelling was conducted to estimate the relationship between SES measures and frailty status in 727 older women. Control variables included race, age, smoking status, insurance status and co-morbidities. Results: Of the sample, 10% were frail, 46% were intermediately frail and 44% were robust. In adjusted models, older women with less than a high school degree had a threefold greater odds of frailty compared with more educated individuals. Those with an annual income of less than

Provider and Clinic Cultural Competence in a Primary Care Setting

10 000 had two times greater odds of frailty than wealthier individuals. These findings were independent of age, race, health insurance status, co-morbidity and smoking status. African-Americans were more likely to be frail than Caucasians (p<0.01). However, after adjusting for education, race was not associated with frailty. The effect of race was confounded by socioeconomic position. Conclusions: In this population-based sample, the odds of frailty were increased for those of low education or income regardless of race. The growing population of older adults with low levels of education and income renders these findings important.

Community Outreach and Cardiovascular Health (COACH) Trial A Randomized, Controlled Trial of Nurse Practitioner/Community Health Worker Cardiovascular Disease Risk Reduction in Urban Community Health Centers

Private and public policymakers and health insurance plans increasingly are examining and introducing disease management programs to help treat chronic illnesses such as cardiovascular disease and stroke. The term disease management programs typically refers to multidisciplinary efforts to improve the quality and cost-effectiveness of care for select patients with chronic illness. This trend highlights the importance of assessing the clinical and public policy implications of this phenomenon from the perspectives of patients’ best interests and quality of care. To address the complex issues surrounding disease management, the American Heart Association (AHA) assembled a multidisciplinary Advisory Working Group on Disease Management in 2002 to offer ongoing guidance in this evolving area. The Advisory Working Group developed a working definition of disease management and established core principles for the application of disease management to cardiovascular disease and stroke, which are the subject of this report. A. Quality of Care The AHA is committed to improving the quality of care that is available to patients suffering from or at risk for cardiovascular disease and stroke through research, public education, advocacy, and the development and application of disease-specific, scientifically based standards and

Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review.

OBJECTIVES The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence womens referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future womens health research. METHODS Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-review literature. RESULTS The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention. CONCLUSIONS Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect womens participation.